“Speaking Up” complaints project

Improving the way the NHS deals with complaints

Background

Good quality complaints handling is vital to ensuring continuous improvement in the quality and safety of care at NHS organisations. It provides a tangible and measurable reflection of the organisations commitment to an open and responsive safety culture. Numerous national reports (National Audit Office, Ombudsman, Health Select Committee etc.) have found that complaints are too often handled poorly by the NHS. The PHSO said “complacency in the system has meant that all too often patient complaints have been ignored”. The recent report stated “when patients make a complaint it is often responded to without compassion or apology, and Boards fail to monitor complaints and learn from mistakes”.

The Patients Association Good Practice standards for NHS Complaints Handling can be viewed here.


The “Speaking UP” project

As part of the Health Foundation funded “Speaking UP” project the Patients Association has developed tools aimed at improving the quality of complaints handling at Mid Staffordshire NHS Foundation and elsewhere. Three key partners worked with us on this two year project : Mid Staffordshire Hospitals Trust (MSHFT) NHS Foundation Trust, Pilgrim Projects and the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD).

There were four key strands to the “Speaking UP” project work – a Complainant Support Service, Digital Patient Stories, Peer Review Panel Process of external review and Complainant Survey. These are outlined below.

We provided a Complainant Support Service at MSHFT to support complainants during the process of making a complaint. Support was provided by Patient Champions, led by a Senior Nurse. They provided active support to complainants who often had complex complaints spanning several organisations and provided complainants with a clear judgement as to whether the complaint had been handled appropriately or not. They supported the complainant until a satisfactory conclusion was reached. This service ceased at the end of May 2013.

In order to ensure that learning from complaints is harnessed and used to improve future care we developed a number of Digital Stories. These stories tell the tales of individual complaint cases from the perspective of the person making the complaint. These have been used in induction and ongoing staff training and are a really powerful way to ensure that the patient voice is clearly heard. The four stories which we developed can be viewed here.

We developed and piloted a Complainant Survey and a Peer Review process to provide qualitative and quantitative feedback on how organisations were dealing with their complaints, highlighting areas of positive performance and areas for improvement using a set of good practice standards, which were developed as part of this project.


Moving Forward – the Peer Review programme

The Peer Review process is based on the methodology used by the National Confidential Enquiry into Patient Outcomes and Deaths (NCEPOD) to review the quality of clinical care across the NHS. We have developed, piloted and refined a scorecard which can be used to review the quality of individual complaints based on the case files. A sample of complaints from the organisation is reviewed to give an overall score and feedback on specific parts of the process the organisation could improve on. It looks at the quality of triage and risk assessment, investigations, decision making and response letters. This scorecard has been developed in partnership with clinicians, complaints managers from the NHS and elsewhere and lay people. The feedback it provides includes both specific process points and general areas for improvement. A copy of the report following the January 2013 peer review panel at Mid Staffs NHS FT can be found here.

We are currently seeking to form a partnership of 10 Clinical Commissioning Groups (CCGs) to invest in the further development of the Peer Review programmes which will enable CCGs to ensure one or more of their major provider organisations can take part in this unique work. Clinical Commissioning Groups are ideal partners in the development of this further activity due to a shared interest in improving governance and quality of the provision of local care and services. As the work represents a process of external review, these activities are a natural partner to the work of scrutiny that CCGs are expected to undertake. In addition CCGs may wish to consider submitting some of their own complaint cases for review. The independence generated by working with Commissioners rather than providers should also strengthen the credibility of the results of the programme. If you are interested in getting involved or would like to discuss this further, please contact Heather Eardley.


Moving Forward – the Complainant Survey

The Complainant Survey is currently being used at 10 Acute NHS Trusts. It asks complainants to rate different aspects of the complaints process:

  • Were they kept informed?
  • Were they made to feel comfortable throughout the process?
  • Did the response answer all their questions?
  • How overall did they rate the experience?

It was piloted at Mid Staffordshire and at a smaller group of five Trusts for a year which has enabled us to improve the survey and the operating procedure for delivering it. We are now seeking to develop it further as evidence based tool for comparing the performance of organisations with the ambition of enabling commissioners to use it as part of Commissioning for Quality and Innovation target by 2014. Trusts who have been involved to date have found the work really valuable in enabling them to identify areas for improvement. As the survey is ongoing, they can then track results to see if results are more positive after improvements have been made.

In particular, the fact that they can benchmark their results against all other participating Trusts is seen as a bonus. Participating Trusts met up on a regular basis to share results and good practice suggestions

We are now opening the survey to any NHS Trusts who would like to be involved. Please contact us so that we can discuss the benefits and costs of signing up. In addition to regular reporting of results each Trust involved will get a free place at our annual Complaints Improvement Conference which will focus on making the best use of the information generated from the Survey to really improve Complaints Handling and subsequently patient care, within the NHS.. If you are interested in getting involved or would like to discuss this further, please contact Heather Eardley.

Results:

We have now received the results from the surveys we conducted at the ten acute trusts. You can see the results here.


Moving Forward – Training and Complaints review

As part of the project, the Patients Association is also developing a programme of support and training to enable providers to improve their complaints handling.

This includes training days for matrons, clinical managers and other staff involved in investigating and preparing responses, the provision of best practice advice and templates for response letters and written tools to support senior managers in decision making.

For an additional fee, a complaints review package is available tailored to your organisations requirements.

Both the training and review will be available at an extra cost, please contact Heather Eardley for more information.


Good Practice Standards

Good quality complaints handling is vital to ensuring continuous improvement in the quality and safety of care at NHS organisations. It provides a tangible and measurable reflection of the organisation’s commitment to an open and responsive safety culture. Numerous national reports have found that complaints are often handled poorly by the NHS.

As long ago as 2004, the Shipman Inquiry stated that “… there is an urgent need for standards which can be applied… in dealing with complaints… These should be established as a matter of urgency…”

When managing a complaint, all those involved (the complainant, staff members etc.) should be treated with respect, tact, compassion and concern for their wellbeing. It is important to listen carefully to what people say and to conduct the investigation in a fair and objective manner.

The Patients Association also believes that organisations should be able to demonstrate to all stakeholders that the investigation and the decision making processes has been:

  • Open and transparent;
  • Evidence based;
  • Logical and rational;
  • Comprehensive and with a level of detail appropriate to the seriousness of the complaint;
  • Timely and expeditious;
  • Proportionate to the seriousness of the complaint(s) raised.

Please click here to access the Patients Association Good Practice standards for NHS Complaints Handling, detailing each of the standards recommended by the Patients Association.


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